This essay will be constructed into five parts. It will firstly define what a group is, secondly explore models of group process, thirdly the considerations involved in setting up a group, fourthly it will discuss the benefits and barriers of group work, lastly it will conclude by summarising the key points of the essay.
A definition of a group will be given in the first part of the essay and what the principles of group work are. In the second part some models of group processes will be explored and what their relevance is to the specific group, such as Bruce Tuckman’s model and Dorothy Stock Whitakers Model. Next a discussion will take place on how to set up a group, including what steps to take before setting up a group using a method on that used by Dorothy Stock Whitaker. Benefits to group work will then be discussed and the barriers staff will encounter in establishing groups. Finally a summary of the key points will conclude the essay.
There are many definitions to what a group is and many different principles or qualities within them. People are part of a group on a daily basis such as a family group. Individuals all have a role in this group such as a mother, daughter, sister or an aunt, a family group is an informal gathering where our personal development is met. Arnold and Boggs describe a group as;
“A gathering of two or more individuals, who share a common purpose, meet over substantial period of time, in face to face interaction, to achieve an identifiable goal.” (Arnold & Boggs, 2007).
For the purpose of the group chosen here, an anxiety management group, it is a group composed for people with similar problems where they can share and gain experience of how to deal with anxiety.
Bruce Tuckman had a model which used five stages of group development, forming, storming, norming, performing and adjourning. This model explains the 5 stages of how a group should develop according to Tuckman.
The first stage is the Forming stage where everyone is getting to know each other maybe even pretend to like everyone. People’s behaviours are generally polite and superficial.
The second stage is the Storming stage here people’s personalities start to show, some conflict may arise in this stage as politeness diminishes, Cliques may form and decisions are hard to make as individuals begin to challenge others, power struggles will be evident in this stage.
The third stage is the Norming stage this is where everyone will be used to each other and trust will have been built between the group. Roles and responsibilities will be defined by this stage and accepted by the other members.
The fourth stage is the Performing stage here the focus is clear the group has a shared goal to achieve, disagreements may arise at this stage but they can be positively and constructively resolved because of the group cohesiveness.
The fifth stage is the adjourning stage this is where the task is complete and the group breaks up and people can move on to new things. This stage is usually discussed throughout the group prior to the ‘end’ so people have the opportunity to prepare and discuss anxieties about the group termination.
The relevance of Tuckman’s model to this specific group is that the group leader/facilitator should be knowledgeable about the theories about group development, group process and group dynamics. Using a specific model for groups as a guide allows the staff to assess what appears to be the ‘normal’ behaviour for members as they approach each stage and assess whether the group is progressing towards making their goals, also it allows them to identify any problems or dysfunctional behaviour that arise. Tuckman’s model is relevant to group establishment as every group has a beginning, middle and an end. The beginning being the forming stage where the group starts and introductions are made, the middle being storming, norming and performing where the group gets to know one another, form alliances and start to open up and build trust. The end is the adjournment stage where the group comes to an end. There is no one model that is used in a specific group and they are not always rigid, meaning they will not follow each of these stages as they come but might go back and forth until the stage is complete then they can move to the next stage.
The group that has been chosen is an anxiety management group for people who are recovering from substance misuse. Anxiety Management programmes are for individuals who are recovering from alcohol and/or drug use. The group is aimed at individuals who experience anxiety, including worry, panic and social phobia, which are stable in regards to substance use but still experience symptoms of anxiety. The group is based upon Cognitive Behavioural Therapy and will explore with service users how thoughts, feelings and behaviours can maintain anxiety. National Institute for Clinical Excellence (2004) has produced guidelines for generalized anxiety and phobias recommending cognitive behavioural therapy as the choice of treatment. Before setting up any type of group there are a few tasks and thoughts to take into consideration before introducing a group in to this area, here the considerations will be discussed. These considerations were taken into account while setting up the anxiety management group.
A thorough assessment or preliminary interviews should be carried out of the service users this can determine whether or not the service user has ability to participate in a group and should be evaluated throughout the group term.
Service users should be asked about the type of groups they have been in and what their experiences are of being in them. If they have been in groups/therapy before such as AA or NA explain that this group is different from those groups it is not a self help group, this group enables the service users to identify their behaviours and find ways to change them through the group experience and learn from others about different ways of coping. The group will have different people with different levels of personal experiences, what they found helpful and what was not so helpful and share these experiences with the rest of the group.
Firstly the service users would need to be asked what their views and opinions were on staff introducing groups in the substance misuse area and what groups they would be most likely to attend if it was to go ahead, this can be done by a questionnaire, face-to-face or by having an informal meeting. This is important because the staff do not want to establish a group that is not going to be well attended, so finding out what is important to the service users is a big consideration. The rest of the staff team would then be informed of what might be going to happen and have a discussion on what their thoughts are and if they would be willing to give up an hour or two each week to facilitate the group. This can be problematic for example if the group was a smoking cessation group staff who smoke or people who have never smoked could have different views and may not want to facilitate it.
Secondly the staff member would take the information that they had collected from the service users/patients and come up with the most common group. They would then do the research into that specific group, what does it involve do they need any other members of the multidisciplinary team to take part, for example an exercise group for the older person do they need a physiotherapist to be there or take part.
Once this research has been done the staff member can start to plan the group.
Dorothy Stock Whitaker (2001) used a similar set of principles to that below while setting up a group.
The staff member would have already identified the group population during questioning of the service users/patients at the start, so this will determine whether it will be an all male, female or mixed sex group. The anxiety management group will be heterogeneous members may be mixed in age, gender, culture, and so on. This is because the service users have similar needs, dealing with anxiety so it seems appropriate to have a mixed level of experiences.
The group leader/facilitator would have to decide whether co facilitation or co-working is appropriate, this is a good way for less experienced facilitators to learn from more experienced facilitators, also co-facilitation provides an opportunity for feedback. The proportion of facilitators to members may make the service users feel threatened or outnumbered and may feel reluctant to open up or share things, according to Whitaker (2001) it is a good rule not to have any more than two members of staff present, including student observers, this can be an advantage it provides the group with two people with different experiences. By having two facilitators in the group one may notice things that the other has missed.
It appears that the structure of the group is important for example the anxiety group will be a time limited group that will run for one and a half hours once a week,
the facilitator should remind the members of this at the start of the group and again when they need to wind up, this can aid the group to run smoothly, if the session is shorter it is not enough time for people to settle in and if it is longer t it might cause restlessness and become tiring.
If the group is going to run once a week the service users need to be informed how long the group will run, for instance 12 weeks, this will depend on the number of topics that will be covered. This is important for the service users to be aware of as they could have other commitments such as child care or even work, so they will need to arrange time off or someone to look after their children.
The size of the group may have an effect on the way the group develops, too small a group will lose opportunities to explore or exchange thoughts or feelings, however too large a group can have the same effect. Literature shows some difference in opinions about how big or small a group should be however most studies say that between six and nine people are just about the right amount.
The location of the groups is important, if it is a community based group people do not want to be travelling an hour on a bus to get there. If it is a hospital based group then the room should be of adequate size, if the room is too small for the group size it could become very warm and people may become uncomfortable and agitated, which may result in conflicts with others, appropriate to hold the size of the group comfortably and away from others so that confidentiality can be maintained, a room that can be block booked for future sessions and be available for the time the sessions will run. If service users were to turn up week after week to a different room or a room being double booked it could make the staff look uninterested or incompetent and they may lose interest which may result in poor attendance. The arrangement within the group room for example is the group going to be sitting in an open circle or around tables; ideally an open circle is recommended however most people feel comfortable sitting round a table as they feel less exposed.
Before the group starts inform the service users/patients and staff about the group that is going to be going ahead, when it will start, what time and how long for. This would also be the trial run so they need to made aware of this. This could be advertised through posters or an information leaflet.
For example the group that is going to be run is an anxiety management group it will run for 10 weeks it will be on a Thursday night at 7:30pm and will last for one and a half hours.
Group facilitators find many ways to open groups for example using ice breakers to ease the tension and then maybe introductions from everyone in the group or vice versa. Moreover it is sometimes appropriate to say nothing and let the service users start the group but as it is an anxiety group this would not be appropriate, as this method would stir up feelings of anxiety and may not be tolerated by the service users, hence the reason they are in the group to begin with. The group agreement/rules may be discussed; this is where the expectations of the group, facilitators and service users will be discussed such as confidentiality, time keeping/attendance and participation in the group. These are all important factors as no one in the group will want their feelings and thoughts discussed with others outside the group; it is hard enough for them to open up.
The biggest benefit of group therapy is helping people to realise that they are not alone. Some of the benefits to being in a group that might attract people to a group could be the fact that it is safety in numbers; someone may feel more confident speaking up in a group than in a one-to-one session.
Meeting up with people in similar situations can diminish the feeling of being isolated or the only one with a particular problem they can receive help and mutual support from someone who has similar problems, this can empower the group and individuals. Working in a group can improve people interpersonal skills and identify their strengths and weaknesses. Group work can offer things like trust games, role play and relationship exercises that members may find helpful as it can teach them or enhance their interpersonal skills, that may not be available elsewhere such as one-to-one meetings. This can be an enjoyable experience that is also helpful and informative to the service users. (Lindsay & Orton 2007)
Groups offer the opportunity to share and this can encourage others to learn effective and positive ways to deal with situations as they arise.
However group work will not suit everyone all of the time some people may feel more isolated as they are not getting the undivided attention they would expect to get from 1:1 meetings, this may result in non-attendance or poor attendance.
Group work might be a drain on resources as it will take extra time to plan and facilitate tasks for example extra staff or to provide provisions such as tea or coffee. The group size can be a factor; a large group can produce fewer opportunities for others in the group to communicate. The group may have a certain degree of conflict at times but this shows that the group is functioning well. The facilitator may find that a particular member may not be suited to the group after a few weeks, but do they exclude the person from the group, this could have negative consequences on the person by doing this, it may make them think negatively in the future about group work and not attend anymore (Whitaker 2001). Some members may think that they will be stigmatised as they are attending a group specifically aimed at addressing their issues and it could be problematic if the group is held in an area such as a hospital which in its self could carry stigma. The group may be expensive to set up as the employment of other agencies may be required such as a trained therapist. (Lindsay & Orton 2007)
The essay used Tuckman,s Model however there are various other models that can be used, the point here is that group leaders/facilitators should be aware of these models/theories and use them as a guide models are a useful tool, it will give insight in to how groups should develop and guide them on what the ‘normal’ behaviours are at each stage of development.
From this account we can see that group work has some good advantages for service users and facilitators, it can empower the service users to venture into new things as they gain new skills and coping strategies from others in the group, however this may not be the case all of the time, others may find that this was the worst experience of their lives. Also that by using a feedback system for the groups the facilitators can learn from these experiences too by asking the service users and co-facilitator what could have been done better, what was not done so well, for example, this can be taken on board to make the service better next and a more enjoyable experience.
We considered the barriers of group work mostly for the service user but also for the facilitators and to acknowledge that these exist they will occur from time to time but not to be disheartened by them, instead we can learn from them.